In the current center cycle, we have designed and began to implement a pilot newborn screening program for sickle cell disease in Ghana, a developing nation in tropical Africa. The program has been incorporated into the public health system and has received great support from public health officials and the people of Kumasi, the site of the project. By design, the project was initially planned to take advantage of the existing public health system. As expected, babies born outside the system as not being tested. The second phase propose to extend the screening program to babies born outside the public health system. Also by design, the initial project did not have a genetic counseling component. We now pro[pose to develop and evaluate a model program of genetic counseling that will be sensitive to the cultural, ethical and religious beliefs of the people whose babies are being tested. We will also evaluate the feasibility of faster, DNA based methods of diagnosis in the screening program that may help improve our follow-up rate.